Healthcare Provider Details

I. General information

NPI: 1750675864
Provider Name (Legal Business Name): EFRAIN ISRAEL CUBILLO IV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4582 N 1ST AVE STE 170
TUCSON AZ
85718-8607
US

IV. Provider business mailing address

4582 N 1ST AVE STE 170
TUCSON AZ
85718-8607
US

V. Phone/Fax

Practice location:
  • Phone: 520-318-6035
  • Fax: 520-318-6035
Mailing address:
  • Phone: 520-318-6035
  • Fax: 520-765-9952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number46229
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: